The Impact of Exposure With No Training: Implications for Future Partner Training Research.

Purpose: This research note reports on an unexpected negative finding related to behavior change in a controlled trial designed to test whether partner training improves the conversational skills of volunteers. Method: The clinical trial involving training in "Supported Conversation for Adults with Aphasia" utilized a single-blind, randomized, controlled, pre-post design. Eighty participants making up 40 dyads of a volunteer conversation partner and an adult with aphasia were randomly allocated to either an experimental or control group of 20 dyads each. Descriptive statistics including exact 95% confidence intervals were calculated for the percentage of control group participants who got worse after exposure to individuals with aphasia. Results: Positive outcomes of training in Supported Conversation for Adults with Aphasia for both the trained volunteers and their partners with aphasia were reported by Kagan, Black, Felson Duchan, Simmons-Mackie, and Square in 2001. However, post hoc data analysis revealed that almost one third of untrained control participants had a negative outcome rather than the anticipated neutral or slightly positive outcome. Conclusions: If the results of this small study are in any way representative of what happens in real life, communication partner training in aphasia becomes even more important than indicated from the positive results of training studies. That is, it is possible that mere exposure to a communication disability such as aphasia could have negative impacts on communication and social interaction. Thismay be akin to what is known as a "nocebo" effect-something for partner training studies in aphasia to take into account.